Dr Alan BarclayLow GI, gluten-free foods.
Coeliac disease is becoming increasingly common, affecting around 1 in 100 people in Australia and the UK, and 1 in 133 Americans.

People with coeliac disease’ own immune system reacts abnormally to the protein gluten found in wheat, rye, and barley (and often a contaminant in oats, depending on where you live), causing damage to their small intestine. The tiny, finger-like projections known as villi which line the small intestine become inflamed and flattened – a condition known as villous atrophy. As a consequence, the surface area of the intestine available for the absorption of nutrients is reduced which can lead to various gastrointestinal and malabsorptive symptoms like diarrhoea and/or constipation, large, bulky foul stools, unwanted weight loss or poor growth in children, flatulence, abdominal bloating, distension or pain, and anaemia. Long-term complications can be very serious and include infertility, miscarriage, depression and dental enamel defects. There is also an increased risk of developing certain forms of cancer such as lymphoma of the small bowel.

If you have a family history of coeliac disease, some or even all of these symptoms, it’s important that you don’t simply self-diagnose coeliac disease and commence a gluten free diet. A diagnosis of coeliac disease can only be made by demonstrating the typical villous atrophy of coeliac disease in a small bowel biopsy. This involves a gastroscopy procedure in which several tiny samples of the small bowel are taken and examined under a microscope. Importantly, you must still be eating gluten regularly before the procedure is performed or you may get a false negative result.

For reasons that we do not yet completely understand, people with type 1 diabetes are at much greater risk (up to 10 times) of developing coeliac disease than people who do not have type 1 diabetes. Both coeliac disease and type 1 diabetes are autoimmune diseases that are ‘triggered’ in genetically susceptible people by as yet unknown environmental factors. Coeliac disease can make management of blood glucose levels even harder than usual in people with type 1 diabetes, with increased risk of both hyper and hypoglycaemia. People with type 2 diabetes or pre-diabetes are thought to have the same level of risk as the rest of the population.

A gluten free diet is currently the only known treatment for coeliac disease and unfortunately it is for life because people with coeliac disease remain sensitive to gluten throughout their life – the condition can never be cured as such. By removing the cause of the disease, a gluten free diet allows the small bowel lining to heal and symptoms to resolve. As long as the gluten free diet is adhered to as strictly as possible, problems arising from coeliac disease should not return.

In the not-too-distant past, having to consume a gluten free diet used to be a culinary disaster. Thankfully, food industry has stepped up to the proverbial plate and there is now just about a gluten free alternative for most of your favourite foods. Many gluten-free core foods like milk, yoghurt, some starchy vegetables, legumes and most fruits also have a low GI. However, many gluten free grain alternatives aren’t low GI, so finding gluten free breads, pasta, breakfast cereals, etc. can still be a challenge. For more information, check out the Low GI Diet for Gluten-free Cooking (ANZ edition; Hachette Australia) or Low GI Gluten-free Eating Made Easy (US/Canada edition; Da Capo).

The GI Foundation has been working with Coles to develop their home-brand range of low GI gluten free foods with real flavour. First on the shelves are five pasta and quinoa products that all carry the GI Symbol.